TY - JOUR
T1 - Post-transplant biliary complications
T2 - An analysis from a predominantly living donor liver transplant center
AU - Wadhawan, Manav
AU - Kumar, Ajay
AU - Gupta, Subash
AU - Goyal, Neerav
AU - Shandil, Rajeev
AU - Taneja, Sunil
AU - Sibal, Anupam
PY - 2013
Y1 - 2013
N2 - Background and Aim: Biliary anastomosis is the Achilles' heel of liver transplant. The reported incidence of biliary complications is 5-15% after deceased donor liver transplantation, and 20-34% after right-lobe live donor liver transplantation (LDLT). We report our experience from an LDLT program. Methods: Between September 2006 and August 2010, 338 liver transplants were performed. Biliary reconstructions were done with an end-to-end choledochocholedochostomy in 307 cases. All recipients were monitored for any evidence of bile leak or stricture. Results: Of 338 transplants performed during this time period, 65 patients had biliary complications (19%). Of these, 30 were biliary leaks, and 35 patients had biliary stricture. Four were cut surface leaks, which settled without any intervention. One patient had leak from primary hepaticojejunostomy, which settled on conservative management. Twenty-five patients had anastomotic leaks, of which 17 underwent endoscopic retrograde cholangiopancreatography and stenting; another eight underwent re-exploration and hepaticojejunostomy. Forty-five patients had biliary strictures. Of these, 10 patients had bile leak initially, followed by biliary stricture. Patients with a double duct anastomosis had a significantly higher risk of developing biliary complications compared with those with a single duct anastomosis. There was no statistically significant difference in survival between those with or without biliary complications. Conclusions: Biliary complications are common after LDLT. Most leaks will subsequently form strictures. Endoscopic retrograde cholangiopancreatography is the first-line treatment for biliary complications, with surgery required in a minority of cases. The incidence of biliary complications is higher in multiple duct anastomoses. Biliary complications are not associated with increased mortality.
AB - Background and Aim: Biliary anastomosis is the Achilles' heel of liver transplant. The reported incidence of biliary complications is 5-15% after deceased donor liver transplantation, and 20-34% after right-lobe live donor liver transplantation (LDLT). We report our experience from an LDLT program. Methods: Between September 2006 and August 2010, 338 liver transplants were performed. Biliary reconstructions were done with an end-to-end choledochocholedochostomy in 307 cases. All recipients were monitored for any evidence of bile leak or stricture. Results: Of 338 transplants performed during this time period, 65 patients had biliary complications (19%). Of these, 30 were biliary leaks, and 35 patients had biliary stricture. Four were cut surface leaks, which settled without any intervention. One patient had leak from primary hepaticojejunostomy, which settled on conservative management. Twenty-five patients had anastomotic leaks, of which 17 underwent endoscopic retrograde cholangiopancreatography and stenting; another eight underwent re-exploration and hepaticojejunostomy. Forty-five patients had biliary strictures. Of these, 10 patients had bile leak initially, followed by biliary stricture. Patients with a double duct anastomosis had a significantly higher risk of developing biliary complications compared with those with a single duct anastomosis. There was no statistically significant difference in survival between those with or without biliary complications. Conclusions: Biliary complications are common after LDLT. Most leaks will subsequently form strictures. Endoscopic retrograde cholangiopancreatography is the first-line treatment for biliary complications, with surgery required in a minority of cases. The incidence of biliary complications is higher in multiple duct anastomoses. Biliary complications are not associated with increased mortality.
KW - Biliary complications
KW - Liver transplant
KW - Living related
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=84878202517&partnerID=8YFLogxK
U2 - 10.1111/jgh.12169
DO - 10.1111/jgh.12169
M3 - Article
C2 - 23432435
AN - SCOPUS:84878202517
SN - 0815-9319
VL - 28
SP - 1056
EP - 1060
JO - Journal of Gastroenterology and Hepatology (Australia)
JF - Journal of Gastroenterology and Hepatology (Australia)
IS - 6
ER -